Effective January 1, 2008 2008 EMPIRE PLAN PREFERRED DRUG LIST Administered by UnitedHealthcare
The following is a list of the most commonly prescribed generic and brand-name drugs included on the 2008 Empire Plan Preferred Drug List. This is not a complete list of all prescription drugs on the preferred drug list or covered under the Empire Plan. This list is subject to change due to FDA approval of new brand and generic drugs and product availability. For specific questions about your prescriptions, coverage and copayments, please call The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and select The Empire Plan Prescription Drug Program. For the enrollee: Enrollees are encouraged to ask their doctors to prescribe generic versions of brand-name drugs whenever appropriate, as this will result in a lower copayment. Generic medications contain the same active ingredients as their corresponding brand-name medications, although they may look different in color or shape. They have been FDA-approved under strict standards. For the physician: Please prescribe generic and preferred products when medically appropriate for your patients.
Biaxin XL*
Actonel*
Allegra-D (g)*
Avonex (PA)
Concerta*
Cardizem LA*
Condylox (g)*
Copaxone (PA)
Betaseron (PA)
Depakote* KEY Generic Drugs are listed in lower case letters. Brand-name drugs are listed with the first letter of the name capitalized. The symbol * next to a brand-name drug signifies that this drug may be available as a generic in 2007 or 2008. When a generic version is available, mandatory generic substitution will apply. Use of a non-preferred brand-name prescription drug when the generic is available will result in the enrollee paying the applicable non-preferred copayment plus the difference in cost between the brand-name drug and the generic, not to exceed the full cost of the drug. The symbol (g) next to a brand-name drug indicates that a generic is currently available for at least one or more strengths of the brand medication. When a generic is available for a particular strength of the brand-name drug, that strength of the brand-name drug is non-preferred. For the drug Dilantin, enrollees will not be charged the difference in cost between the brand-name drug and the generic version when the brand- name drug is dispensed instead of the generic. The symbol (PA) next to a drug name indicates that prior authorization is required. You can get more information about your prescription drug benefits by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and selecting The Empire PlanPrescription Drug Program. From the homepage, http://www.cs.state.ny.us, select either Employees or Retirees and follow the links to Health Benefits. Select your group andbenefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List.
Depakote ER*
Imitrex*
Meridia (PA)
Dilantin (g)
Infergen (PA)
Intal (g)*
Intron-A (PA)
Dovonex*
Forteo (PA)
itraconazole (PA)
Fosamax*
Fosamax Plus D*
Enbrel (PA)
Lamictal (g)*
Hepsera*
Humatrope (PA)
Humira (PA)
Norditropin (PA) KEY Generic Drugs are listed in lower case letters. Brand-name drugs are listed with the first letter of the name capitalized. The symbol * next to a brand-name drug signifies that this drug may be available as a generic in 2007 or 2008. When a generic version is available, mandatory generic substitution will apply. Use of a non-preferred brand-name prescription drug when the generic is available will result in the enrollee paying the applicable non-preferred copayment plus the difference in cost between the brand-name drug and the generic, not to exceed the full cost of the drug. The symbol (g) next to a brand-name drug indicates that a generic is currently available for at least one or more strengths of the brand medication. When a generic is available for a particular strength of the brand-name drug, that strength of the brand-name drug is non-preferred. For the drug Dilantin, enrollees will not be charged the difference in cost between the brand-name drug and the generic version when the brand- name drug is dispensed instead of the generic. The symbol (PA) next to a drug name indicates that prior authorization is required. You can get more information about your prescription drug benefits by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and selecting The Empire PlanPrescription Drug Program. From the homepage, http://www.cs.state.ny.us, select either Employees or Retirees and follow the links to Health Benefits. Select your group andbenefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List.
Nutropin (PA)
Ventavis (PA)
Pulmicort Flexhaler*
Tazorac (PA)
Tegretol XR*
Wellbutrin XL (g)*
terbinafine (generic Lamisil) (PA)
Oxycontin (g)*
Tev-Tropin (PA)
Pancrease MT (g)*
Peg-Intron (PA)
Rebif (PA)
Pegasys (PA)
Retin-A Micro Gel (PA)
Tracleer (PA)
phentermine (PA)
Revatio (PA)
Zyrtec-D*
Risperdal (except for M-Tab)*
Roferon A (PA)
tretinoin (PA)
Serevent*
Serostim (PA)
Precose*
Trusopt* KEY Generic Drugs are listed in lower case letters. Brand-name drugs are listed with the first letter of the name capitalized. The symbol * next to a brand-name drug signifies that this drug may be available as a generic in 2007 or 2008. When a generic version is available, mandatory generic substitution will apply. Use of a non-preferred brand-name prescription drug when the generic is available will result in the enrollee paying the applicable non-preferred copayment plus the difference in cost between the brand-name drug and the generic, not to exceed the full cost of the drug. The symbol (g) next to a brand-name drug indicates that a generic is currently available for at least one or more strengths of the brand medication. When a generic is available for a particular strength of the brand-name drug, that strength of the brand-name drug is non-preferred. For the drug Dilantin, enrollees will not be charged the difference in cost between the brand-name drug and the generic version when the brand- name drug is dispensed instead of the generic. The symbol (PA) next to a drug name indicates that prior authorization is required. You can get more information about your prescription drug benefits by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and selecting The Empire PlanPrescription Drug Program. From the homepage, http://www.cs.state.ny.us, select either Employees or Retirees and follow the links to Health Benefits. Select your group andbenefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List. Examples of Non-Preferred Brand-Name Drugs with 2008 Empire Plan Preferred Drug List Alternatives Non-Preferred Drugs Empire Plan Preferred Drug List Alternatives
Geodon*, Risperdal (except for M-Tab)*,Seroquel (except for XR), Zyprexa (except for Zydis)
omeprazole (generic Prilosec), Nexium, Prevacid
estradiol patch, Esclim, Estraderm, Vivelle, Vivelle-Dot
zolpidem (generic Ambien), temazepam, flurazepam, triazolam, Sonata*
zolpidem (generic Ambien), temazepam, flurazepam, triazolam, Sonata*
Benicar HCT, Diovan HCT, Hyzaar, Micardis HCT
Atrovent Inhaler*,Spiriva
Benicar HCT, Diovan HCT, Hyzaar, Micardis HCT
Asmanex, Flovent, Pulmicort Flexhaler*, QVAR
clindamycin, benzoyl peroxide/erythromycin, Duac
azithromycin (generic Zithromax), clarithromycin (generic Biaxin)
amlodipine (generic Norvasc) plus Lipitor
fexofenadine (generic Allegra), Zyrtec*
pseudoephedrine/chlorpheniramine, Allegra-D (g)*, Zyrtec-D*
venlafaxine (generic Effexor), Effexor XR
Differin (PA)
tretinoin (PA), Retin-A Micro Gel (PA), Tazorac (PA)
Genotropin (PA)
Humatrope (PA), Norditropin (PA), Nutropin (PA), Tev-Tropin (PA)
econazole, ketoconazole, nystatin, Naftin
zolpidem (generic Ambien), temazepam, flurazepam, triazolam, Sonata*
citalopram (generic Celexa), fluoxetine (generic Prozac), sertraline (generic Zoloft),paroxetine (generic Paxil), Lexapro
omeprazole (generic Prilosec), Nexium, Prevacid
Provigil (PA)
amphetamine with dextroamphetamine salt combination,dextroamphetamine, methylphenidate, Adderall XR, Concerta
fluticasone (generic Flonase), flunisolide, Nasacort AQ, Nasonex
levonorgestrel-ethinyl estradiol tablet, dosepack, 3 month (generic Seasonale)
KEY Generic Drugs are listed in lower case letters. Brand-name drugs are listed with the first letter of the name capitalized. The symbol * next to a brand-name drug signifies that this drug may be available as a generic in 2007 or 2008. When a generic version is available, mandatory generic substitution will apply. Use of a non-preferred brand-name prescription drug when the generic is available will result in the enrollee paying the applicable non-preferred copayment plus the difference in cost between the brand-name drug and the generic, not to exceed the full cost of the drug. The symbol (g) next to a brand-name drug indicates that a generic is currently available for at least one or more strengths of the brand medication. When a generic is available for a particular strength of the brand-name drug, that strength of the brand-name drug is non-preferred. For the drug Dilantin, enrollees will not be charged the difference in cost between the brand-name drug and the generic version when the brand- name drug is dispensed instead of the generic. The symbol (PA) next to a drug name indicates that prior authorization is required. You can get more information about your prescription drug benefits by calling The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) and selecting The Empire PlanPrescription Drug Program. From the homepage, http://www.cs.state.ny.us, select either Employees or Retirees and follow the links to Health Benefits. Select your group andbenefit plan if prompted. On the resulting NYS Online health benefits page, select “Using Your Benefits” and scroll down to the 2008 Empire Plan Preferred Drug List.
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